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PAIN WITHOUT A CAUSE: MYOFASCIAL PAIN

Unlike fibromyalgia, myofascial pain is localized to one area. There are tender points where pressing will often result in pain, which spreads to distant areas and imitates the pain of which the patient complains. Under the tender points, a taut band of muscle can be felt. The pain may be alleviated by stretching the muscle in the band, by injecting local anaesthetic into it, or by pushing a needle into it. In the 1930s, some early pain experts imitated this condition in themselves by injecting a small volume of concentrated salt solution into a muscle or ligament. They felt the pain spread to a distant area from the injection site and persist for up to a day. The patients may be unable to move the muscle in which the trigger point and taut band lie or, if they do move the muscle, it provokes the pain. Myofascial trigger points may appear in the region of injury to the vertebrae as in whiplash accidents. Many studies have examined biopsies taken from the area of a trigger point and have found no abnormality. The taut band is produced by contracting muscle, but this is not strong enough to produce a cramp. In some patients, the pain lasts for up to two months and disappears with no after effects. There have been no controlled studies but recovery may be speeded by treatment of the local tender spots and by exercise. When the pain has lasted for six months or more the prognosis becomes progressively worse. Local treatment of the tender spots provides temporary relief but the tenderness returns.
In these conditions, patients are convinced that the problem and cause must reside at the tender spot. Because no convincing abnormality has been found at the tender spots, the cycle with which the reader is now familiar starts up. Many doctors believe that it is impossible to have a local pain without a local cause. Therefore, because they can demonstrate no local cause, they conclude that the disease does not exist. This is a dogmatic throwing out of the baby with the bath water. There are logical hypotheses that could be tested to give these conditions the honour of an open investigation. For example, the taut bands could be caused by the firing of a few motor neurons in the spinal cord in a hyperexcitable area which also produced sensation. As it is, this disease with no cause is not even diagnosed in Britain with a proper title, even though doctors admit to having observed it.
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